During the 10-year interval from 1976 through 1985, 50 patients with congenital absence of the vagina underwent McIndoe vaginoplasty at our institution. The medical records of these patients were retrospectively reviewed, and additional information was obtained through a survey of the patients. The mean duration of follow-up was 6.5 years. Two rectovaginal fistulas and one graft failure were among the complications that occurred. Five patients required additional reconstructive vaginal operations. Operative vaginoplasty was considered functionally successful by 40 of the 47 patients (85%) who responded to the survey, yet only 36 of these 40 (90%) had remained coitally active by the time of the survey. Recognizing the potential for complications, the need for long-term follow-up and care of the neovagina, and the less-than-perfect results achieved, we continue to consider the McIndoe operation as the procedure of choice for most patients with vaginal agenesis.